Medical Advancements Versus the Status Quo

Medical research inherently seeks to improve approaches to clinical care.

Scientific research is a challenge
to the status quo. It is based on
an innate desire to know more
or an assumption that improvements
always can be made. In medicine, this
translates into a perpetual impetus to
improve patient health outcomes and
quality of life. In this regard, investigators
often question the wisdom of current clinical practice and test
whether alternative patient management
approaches could be better.

Here are examples of just such efforts. A phase 2 study led
by Brian I. Rini, MD, of Cleveland Clinic, tested whether
active surveillance (AS) can be an appropriate management strategy for
patients who have metastatic renal cell carcinoma (mRCC), for whom
immediate systemic treatment is usually recommended. As Dr Rini
stated, the study demonstrated that a subset of patients with mRCC
have slow-growing disease that can be managed safely using active surveillance,
“which could spare them the inconvenience and debilitating
side effects of aggressive treatments for about a year, and in some cases
several years, without worsening anxiety and depression.” The study,
which was published in The Lancet Oncology, included only 52 patients,
but the results, if confirmed by larger trials, could give clinicians another
option to offer selected mRCC patients, one that could delay systemic
therapy and its adverse effects.

In another study, published in European Urology, Pär
Stattin, MD, of Uppsala University in Uppsala, Sweden, and colleagues
demonstrated that radical local treatment may decrease mortality in
men with very high-risk prostate cancer, for whom clinical guidelines
recommend only androgen deprivation therapy (ADT). The study was a
semiecologic population-based investigation, and, as Dr Stattin's group
pointed out, the findings need confirmation in randomized controlled
trials. Still, their study may represent an important step forward in
providing these men with a possible way to avoid the complications
associated with ADT.

Lastly, in a study published in the Clinical Journal of the American
Society of Nephrology, Matthew J. Oliver, MD, of Sunnybrook Health
Sciences Centre in Toronto, and colleagues compared hospitalization
rates associated with assisted peritoneal dialysis (PD) and in-center
hemodialysis (HD) and found no significant difference.
Assisted PD is a treatment option for patients who would like to receive
dialysis at home but have significant barriers to self-care. Evidence that
this modality can be a safe alternative to in-center HD could promote
its use among certain populations—such as the elderly—for whom
traveling to an HD center can be disruptive and inconvenient.
At this point, these studies only offer the promise of better patient
management, but they also exemplify how advancements in medicine
stem from researchers' nonacceptance of the status quo.